MEDICARE: CHARM CITY MEDICAL ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1710012463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARM CITY MEDICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1777 REISTERSTOWN RD
Second Line	:	SUITE 222
City	:	BALTIMORE
State	:	MD
Zip	:	21208-1306
Country	:	US
Telephone Number	:	410-415-0933
Fax Number	:	410-415-0939

Provider Business Practice Location Address
First Line	:	1777 REISTERSTOWN RD
Second Line	:	SUITE 222
City	:	BALTIMORE
State	:	MD
Zip	:	21208-1306
Country	:	US
Telephone Number	:	410-415-0933
Fax Number	:	410-415-0939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAPHAEL PEREZ MERA
Credential	:	MD
Telephone Number	:	410-415-0933

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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Directions to “CHARM CITY MEDICAL ASSOCIATES PA ” Practice Location

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